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Why Getting Pregnant After Cervical Cancer Needn't Be A Struggle

A diagnosis of cervical cancer is overwhelming and may be associated with worries about how it will impact your ability to conceive. While some cervical cancer treatments can harm fertility, there are options to help protect your ability to become pregnant after treatment. The management of cervical cancer requires a range of multimodal treatments. Fertility may suffer as a result of some these therapies, so let's take a closer look at the potential effects of various treatments on fertility: 

Surgery: The uterine body is connected to the vagina by the cervix, which is the bottom portion of the uterus. Cervical cancer can treated with many forms of surgery. The uterus and cervix, for instance, might be removed. Since a fetus or developing baby, grows and lives inside the uterus, it's not feasible to carry a pregnancy when both the uterus and cervix are removed.

Radiation therapy: This may be administered to the pelvic region where cervical cancer is diagnosed in certain patients. Fertility may be impacted if it damages the ovaries and uterus and impairs their capacity to function.

Chemotherapy: Reproductive organs are harmed by certain chemotherapy (chemo) medications used to treat cervical cancer. Fertility may be impacted if this results in early menopause. Patients who are taking large doses of one or more of these chemo medicines are especially at risk for this. 

That said, let me hurry to add that it is possible for women to become pregnant after being diagnosed with cervical cancer.  A 2020 study, Fertility-Sparing Treatment for Early-Stage Cervical, Ovarian, and Endometrial Malignancies, for instance, discovered that almost half of the patients who underwent fertility-sparing surgery, and subsequently, attempted to conceive were successful in becoming pregnant. It is paramount to understand that receiving a cervical cancer diagnosis does not preclude you from becoming a parent. However, it truly depends on the disease's stage, severity, and intended course of treatment. 

Women diagnosed with cervical cancer have a number of alternatives for preserving their fertility. For instance, trachelectomy and conization – procedures that preserve fertility – may be an option for certain individuals. In these surgeries, the entire cervix or a part of it is taken out, while retaining the uterus. This form of treatment helps preserve the patient's   capacity to carry a pregnancy. 

In circumstances where fertility-sparing surgery may not prove feasible, there are alternative preservation techniques. These include the freezing of eggs and embryos. These operations are typically safe to do prior to the start of cancer treatment. Additionally, ovarian transposition may be a possibility for patients undergoing radiation treatment. In this surgery, the ovaries are removed from the area undergoing radiation, in order to protect them. 

Before starting treatment, it is imperative  that you consult your doctor especially if you intend to become a parent after remission. You need to have "the conversation" early on to think about ways you can preserve fertility, whether through ovarian transposition, freezing of eggs or embryos, or surgery. As with most life-threatening ailments, it's important to state that delaying therapy shouldn't come at the expense of maternal survival. And any changes to the conventional treatment must be carefully discussed with the patient and her partner/family before being considered. 

Dr Pratima Raj is associate consultant, gynaecological oncology at Manipal Hospital, Old Airport Road, Bengaluru. 

Black Women Are Dying From Cervical Cancer At Alarming Rates—Here's Why

Cervical cancer is a slow-growing cancer that occurs in the cervix, the lower part of the uterus that connects to the vagina. This area, which has a donut-shaped structure, plays a crucial role in reproductive health. The primary cause of cervical cancer is the human papillomavirus (HPV), a common virus transmitted through sexual contact. While many people who contract HPV do not experience health consequences, certain high-risk strains of the virus can lead to cervical cancer over time if left undetected and untreated.

Cervical Cancer in the Black Community

Cervical cancer disproportionately affects Black women, who tend to have worse outcomes and higher mortality rates than other racial groups. In fact, Black women are 41 percent more likely to develop cervical cancer than white women and are 75 percent more likely to die from it. What's more, Black women are more likely to be diagnosed at a later stage, which contributes to low five-year survival for a type of cancer for which almost every case can be prevented.  

According to the St. Jude HPV Cancer Prevention Program, Black women are more likely to die from the disease due to:

Medical mistrust. There is a generational medical mistrust among Black women, which can lead to delayed diagnoses. 

Lack of follow-up care. St Jude notes that Black women have the lowest follow-up rates after an abnormal screening. According to Human Rights Watch, these problems become greater as women age. In fact, Black women over the age of 70 are three times more likely to die from cervical cancer, despite screening guidelines ending at 65.

Lack of information. Many people lack accurate information about HPV vaccinations and how people get HPV.

While it's true that women in general could improve follow-ups and health literacy, a significant factor often overlooked is medical racism. Implicit bias within the healthcare system can lead to primary care providers (PCPs) deprioritizing or overlooking preventive screenings for Black women, contributing to delayed diagnoses and poorer health outcomes. Studies have shown that Black patients are less likely to receive timely screenings, adequate pain management, and even referrals for specialist care compared to their white counterparts. Addressing these systemic issues is just as crucial as encouraging individual health advocacy.

RELATED: 5 Warning Signs Of Cervical Cancer Every Black Woman Should Know

The Connection Between HPV and Cervical Cancer

HPV is a sexually transmitted infection (STI) with over 100 different strains, some of which are classified as high-risk because they can cause abnormal cell changes in the cervix. 

"If someone has one of those, a lot of times there are no symptoms. It can just continue to affect the cervix, leading to abnormal cells. Over time, if there's no detection or awareness, it can continue to develop and eventually turn into cancer," Joyce Idehen, MD tells BlackDoctor.Org

The Importance of Early Detection: Pap Smears & HPV Testing

Early detection is critical in preventing cervical cancer. A Pap smear is a test that collects cervical cells to check for abnormalities, while an HPV test detects the presence of HPV strains, including high-risk ones. Women over the age of 30 should receive both tests together every five years, while women aged 21–29 should receive Pap smears alone every three years. If abnormalities are detected, further testing or treatment can prevent cancer from developing.

"Patients can ask their doctor during their annual visit when they're due for their next pap smear. Even if it can't be done the same day, providers can schedule it," Dr. Idehen adds.

If you're unsure of when you had your last Pap smear, request access to your previous medical records and bring them to your next appointment.

RELATED: 10 People You Need on Your Cervical Cancer Care Dream Team

Dispelling Myths About HPV & Cervical Cancer

There are many misconceptions surrounding HPV and cervical cancer, including:

HPV vaccines are only for girls: The vaccine is recommended for both boys and girls starting at age nine, and adults can receive it up to age 45.

Only women are affected by HPV: HPV can cause cancers in men, including penile, anal, and throat cancers.

Only people with multiple sexual partners are at risk: HPV is incredibly common, and anyone sexually active can contract it.

Risk Factors for Cervical Cancer

Some factors that increase the risk of developing cervical cancer include:

Lack of routine screenings (Pap smears and HPV tests)

Having multiple sexual partners (increasing exposure to HPV)

Smoking, which weakens the immune system and makes it harder to fight HPV

A weakened immune system (e.G., due to HIV)

Prevention Strategies

The most effective ways to prevent cervical cancer include:

Getting the HPV vaccine as early as possible

Practicing safe sex, including condom use

Ensuring you're up to date on pap smears and HPV screenings 

Avoiding smoking, which can increase cervical cancer risk

Encouraging Open Conversations

Discussing HPV and cervical cancer with partners, family, and friends helps normalize the conversation and promotes prevention. Men should also be involved in the discussion, as they can carry and spread HPV. Encouraging male partners to get vaccinated and tested can help reduce the risk for both partners.

"Open conversations with partners about vaccination and testing are key. Men also play a role—not just as partners but in encouraging their sisters, mothers, and others to take these steps. Awareness shouldn't just fall on women," Dr. Idehen advises. 

Resources for Those Without Insurance

For those who lack health insurance, affordable and free resources are available:

Federally Qualified Health Centers (FQHCs) offer low-cost or free Pap smears and HPV vaccines.

Planned Parenthood provides sexual health services, including HPV vaccinations and STI screenings.

RELATED: 10 Questions you Should Ask Your Doctor About Cervical Cancer

Final Thoughts

Cervical cancer is preventable with regular Pap smears, HPV vaccination, and safe sexual practices. It's important for both men and women to be proactive about their sexual health, have open discussions, and advocate for early detection. Spreading awareness and ensuring equitable access to preventive care can help save lives.

"For women, take ownership of your preventive care—get your routine Pap smears and, if not vaccinated as a child, get vaccinated now. For men, get vaccinated and take responsibility for your sexual health. Prevention is key, and it's never too late to make these health changes," Dr. Idehen concludes. 

If you haven't had your Pap smear or HPV vaccine, schedule an appointment today—it could make all the difference.

Medically Reviewed By:

Joyce Idehen, MD

Joyce earned her Bachelor's in Nursing from Prairie View A&M before completing her medical degree at the American University of Antigua. She is the Social Media Manager for Black Girl White Coat, a nonprofit that mentors and motivates underrepresented minorities in medicine.

Inadequate Cervical Cancer Prevention And Care For Black Women In The United States Mississippi Delta

One of the major problems that African Americans have is not having access to care or not being able to afford the care that they're given, that [is] actually needed. So, a lot of times, African Americans cannot afford the care. … And then African American females are at higher risk of having cervical cancer. Why? Because a lot of them are not actually going for regular checkups. They can't afford it, they can't get there. So that's one of the main issues.

—Mia R. (pseudonym), Washington County, February 14, 2024

Cervical cancer is a highly preventable and treatable disease that typically develops over several years, providing ample time to detect and treat abnormal changes in cervical cells that could eventually lead to cancer. With access to comprehensive reproductive health care, including information, preventive services, and adequate gynecological care, almost all cases of cervical cancer can be prevented or treated at an early stage. Yet, in the United States, the American Cancer Society (ACS) estimates that approximately 4,360 women will die from cervical cancer in 2024.

There are persistent and glaring racial disparities in rates of cervical cancer deaths in the US. Black women die of the disease at a disproportionately high rate. According to the ACS, the mortality rate for Black women is around 65 percent higher than for white women.

Black women are more likely to be diagnosed with cervical cancer at a later stage and face a lower five-year survival rate (that is, the percentage of people who are alive five years after their diagnosis). Mississippi is the state with the highest rate of cervical cancer deaths in the United States. Black women in Mississippi are almost 1.5 times as likely to die of the disease as white women living in the state, despite Black and white women having nearly identical incidence rates.

Mississippi also has the highest percentage of Black residents in the United States; about 38 percent of the population in Mississippi is Black. Black Mississippi residents are over twice as likely to live in poverty compared to white residents in the state (32 percent versus 13 percent) and Black women in Mississippi are over four times as likely to die of pregnancy-related complications than white women.

In the Mississippi Delta, a rural region with some of the worst health indicators and highest rates of poverty in Mississippi and in the entire United States, racial disparities are even starker, and Black women have an even greater risk of dying from cervical cancer. From 2017 to 2021, Black women living in the Delta were about 1.4 times more likely to die of the disease compared to white women living in the same region.

Structural racism, discrimination, poverty, and inequality contribute to preventable deaths from cervical cancer. Human Rights Watch research in Alabama in 2018 and joint research with the Southern Rural Black Women's Initiative for Economic and Social Justice (SRBWI) in Georgia in 2022 documented unequal access to cervical cancer prevention and care and differences in cervical cancer outcomes for Black women living in rural communities. Such disparities stem from social exclusion and structural barriers to accessing health care, including the inadequate availability and accessibility of information and services needed to prevent and treat cervical cancer. These preventable deaths from cervical cancer represent the failure of federal, state, and local governments to realize human rights for all people, namely the right to the highest attainable standard of health and to comprehensive, affordable, and accessible reproductive healthcare services and information.

Between May 2023 and November 2024, SRBWI and Human Rights Watch partnered with 10 community-based researchers and a research associate based in the Delta to document factors contributing to the disproportionate rate of cervical cancer deaths for Black women in the Mississippi Delta. Between September 2023 and April 2024, the community-based researchers and research associate interviewed 159 Black women ages 19 to 81 in Bolivar, Humphreys, and Washington counties. In addition, SRBWI and Human Rights Watch spoke with community members, academics, medical providers, public officials, and members of nongovernmental health, reproductive rights, and justice groups in Mississippi.

Access to Cervical Cancer Prevention and Care in the Mississippi Delta is Inadequate and Worsened by State Policies

Our research found that women in the Mississippi Delta lack adequate access to cervical cancer prevention and care, and that the state, local, and federal governments have not done enough to ensure such access. Instead of ensuring access to comprehensive and affordable health care for all residents, Mississippi state policies—including its failure to expand Medicaid, the US public health insurance program for people with low-incomes, and its near total ban on access to abortion with extremely limited exceptions—have created additional barriers to accessing health care. Mississippi has one of the highest rates of uninsured individuals in the United States. As of 2022, an estimated 10.8 percent of the state's population did not have health insurance. As of January 2023, almost 18 percent of women of reproductive age (18 to 44) were uninsured, and rates were even higher for women of color.

The Mississippi state government's actions helped create this dire situation. Mississippi is one of the 10 states in the United States that have not expanded Medicaid through the Affordable Care Act (ACA), which would have extended healthcare coverage to more low-income individuals. Instead, Mississippi has seen a significant drop in Medicaid enrollment since March 2023, when the continuous coverage provision of the Families First Coronavirus Response Act (FFCRA), enacted at the start of the Covid-19 pandemic in 2020, ended. From then to June 2024, Medicaid enrollment in Mississippi decreased by 26 percent.

Mississippi's failure to expand Medicaid, which has also contributed to rural hospital closures, has also helped fuel a shortage of obstetrician-gynecologists (ob-gyns) in the state. The problem of hospital closures—and a resulting healthcare crisis in the state—continues to worsen. A December 2024 report from the Center for Healthcare Quality and Payment Reform found that more than half of rural inpatient hospitals in Mississippi were at risk of closing, with 25 at risk of immediate closure, making Mississippi the state, along with New York, with the second highest percentage of rural hospitals at risk of immediate closure.

These hospital closures have reduced the number of health facilities and medical personnel available to help prevent and treat cervical cancer. This decline is made worse by a shortage of gynecologists and inadequate public transportation, which can make Freaching existing services difficult if not impossible for many underserved women requiring care, especially in extremely rural areas like the Delta. Currently, Mississippi has a severe shortage of ob-gyns. More than half of its 86 counties, including 8 of the 18 counties in the Mississippi Delta, are considered "maternity care deserts," without hospitals or birth centers providing obstetric care, ob-gyns, or certified nurse midwives or midwives. Only seven counties in the Mississippi Delta have any licensed ob-gyns.

The state of Mississippi's hostility toward reproductive rights and its restrictive law on abortion access has also harmed access to gynecological care. Mississippi banned abortion in June 2022 following the Dobbs v. Jackson's Women Health Organization decision, in which the US Supreme Court overturned Roe v. Wade and eliminated the constitutional right to abortion access. After Roe v. Wade was overturned, medical students reported that restrictive laws on abortion access have deterred them from practicing in states where abortion is banned. States with abortion bans have fewer ob-gyns and maternity care providers, more "maternity care deserts," and higher rates of maternal mortality and infant death, especially among women of color. Research in states with abortion bans has shown that people seeking a broad range of pregnancy-related health care experience life-threatening delays and denials of care.

Because Mississippi does not provide comprehensive and affordable healthcare coverage, low-income and uninsured women, especially those who do not qualify for Medicaid under the state's restrictive enrollment requirements, must rely on a patchwork of various state and federal programs to access reproductive healthcare services. Each of these programs have different eligibility criteria and often limit coverage to only certain services. This creates fluctuating access to healthcare services, gaps in cervical cancer prevention and care, and a system that can be very difficult for people in need of health care to navigate.

Without health insurance that makes care affordable, low-income and uninsured women in Mississippi—who are disproportionately Black—face significant barriers to obtaining comprehensive reproductive health care, including routine cervical cancer screenings and follow-up care after abnormal test results. Women we interviewed told us that at times they go without or delay important medical appointments because of cost, including cervical cancer screenings and follow-up care, forgoing lifesaving opportunities to prevent and treat the disease. 

In addition to state laws and policies that make it harder for people to access comprehensive reproductive health care, Mississippi has also failed to provide adequate, accessible, and affordable public transportation throughout the state, including in rural areas like the Mississippi Delta. In the Delta, an extremely rural region where healthcare facilities are sparse and spread out, adequate and affordable transportation has always been essential to accessing health care. Given a lack of ob-gyns and adequate access to comprehensive reproductive health care in many parts of the Delta, inadequate transportation options that cannot meet demand have made accessing cervical cancer care, including follow-up care requiring a specialist, impossible for some. Many of the women interviewed for this report described needing to travel over an hour to access gynecological care and facing significant practical and financial obstacles to doing so, due to a lack of affordable transportation options, public or private.

Distrust of Medical Providers, Racism, and Racial Discrimination Negatively Impact Cervical Cancer Prevention and Care

Reported distrust of medical providers and the healthcare system—often arising from demeaning experiences, concerns around quality of care, health insurance status, and a lack of confidentiality—impacts some women's willingness to seek reproductive and gynecological care. These negative experiences can and have led to distrust of medical providers, including gynecologists, and can cause some women to avoid getting necessary cervical cancer prevention and care. Our research found that structural racism and discrimination within the healthcare field impacts the quality of care many Black women receive, their level of trust and confidence in medical providers, and, for some, even their willingness to engage with the healthcare system. In addition, racism and discrimination leads to unequal gynecological care and differences in treatment for Black women, with studies showing that Black women are less likely to receive recommended cervical cancer treatment, including surgery at an early stage.

Inadequate Efforts to Ensure Access to Information on Sexual and Reproductive Health and Encourage HPV Vaccine Uptake

Women and girls in Mississippi do not have adequate access to the information they need to make informed decisions to prevent and treat cervical cancer, including information on the human papillomavirus (HPV), the HPV vaccine, and its role in preventing cancer. State policies have failed to ensure that all young people receive comprehensive, inclusive, rights-based, and scientifically accurate information on sexual and reproductive health. Consequently, many people in Mississippi lack lifesaving information, including about the HPV vaccine, and many women and girls do not fully understand the steps they can take to prevent cervical cancer and stay healthy and safe throughout their lifetime.

Mississippi has both high rates of HPV-related cancers and low HPV vaccination rates. By 2023, approximately 38 percent of adolescent children ages 13 to 17 in the state had received all recommended doses of the HPV vaccine, and Mississippi ranked last in the United States for HPV vaccination rates. A lack of knowledge of the HPV vaccine has contributed to low vaccination rates not only in Mississippi, but also across the United States. Fewer than half of the women SRBWI and Human Rights Watch interviewed reported being knowledgeable about the HPV vaccine and its role in preventing cancer, including several parents of adolescents ages 10 to 19 living at home who had not received the vaccine. This lack of information on sexual and reproductive health also fuels misinformation, fear, and stigma and prevents many women from openly discussing their health concerns or seeking care.

To address the urgent situation in Mississippi, where women of reproductive age currently face the worst outcomes for women's health in the country, state and federal agencies should do much more to eliminate the barriers women and girls face to accessing lifesaving health care.

Everyone has the human right to the highest attainable standard of physical and mental health. Under international human rights law, the United States—and each of its 50 states—is obligated to respect, protect, and fulfill the rights to health, information, equality, and nondiscrimination, all of which are relevant to its obligation to protect and promote the rights of women and girls in Mississippi. The state should take concrete steps to reduce racial disparities in cervical cancer outcomes and ensure the health and rights of all women and girls by: expanding Medicaid to increase access to affordable health care for Mississippi residents; ensuring comprehensive sexual and reproductive health information and services, including cervical cancer prevention and care, are available and accessible in all areas of the state, including in the Mississippi Delta; and passing legislation to raise awareness of the human papillomavirus (HPV) vaccine and increase HPV vaccination rates in Mississippi.

 

The Mississippi Delta is a region of rich, fertile soil, renowned for its contributions to civil rights activism, blues, art, and storytelling. Home to both the plantation economy and the civil rights movement, the region is one of contrasts—of subjugation and achievement, of structural poverty and inequality, and of resilience and community innovation. Here, trailblazers like Medgar Evers, Fannie Lou Hamer, and Unita Blackwell planted seeds of change and advancement that continue to flourish today.

Among the Delta's trailblazers, Dr. Robert Smith transcended the barriers of racism through a life dedicated to civil rights and medical activism. From Tougaloo College to Howard University College of Medicine, to his return to the Delta, Dr. Smith's career helped to lay the foundation for community-based health care in the Delta, highlighting the critical role of grassroots activism and collective care in transforming health outcomes. He was one of the first Black physicians to confront racist policies in the American Medical Association and in Delta hospitals, challenging restrictions that denied Black doctors and patients access to care. Alongside the Children's Defense Fund founder and President Emerita, Marian Wright Edelman, he spotlighted the medical neglect of Mississippi's children. In 1962, he co-founded the Medical Committee for Human Rights, providing care to civil rights activists, and later spearheaded the establishment of the first federally qualified health center (FQHC), Delta Health Center, in Mound Bayou, Bolivar County. Currently, Delta Health Center serves about 15,000 patients each year, fostering access to health care and addressing social determinants of health impacting the well-being of historically underserved communities in Mississippi. Its 20-acre farm in Mound Bayou provides fresh fruits and vegetables for the community— something many people in the Delta struggle to obtain. Today, FQHCs are one of the main providers of health care for people without means in the United States, and this model Dr. Smith helped initiate has saved countless lives and has had a lasting impact in Mississippi and across the entire US.

Yet, despite the progress made, the Delta's landscape still reflects historical disparities where Black women and families often bear the brunt of systemic inequities. This research, inspired by the legacy of Dr. Smith and other trailblazers, seeks to illuminate persistent gaps in access to quality health care and health inequalities through the lived experiences of those most impacted. Through this report, we aim to foster a future that honors the lives and well-being of all Delta residents, bridging these gaps and building a healthcare system rooted in equity, access, and justice for all.

 

To the Mississippi State Government To the Governor

Support the expansion of Medicaid under the Affordable Care Act (ACA) to increase access to health care, including cervical cancer care, for Mississippi residents.

Develop and implement a comprehensive, rights-respecting plan to eliminate cervical cancer deaths as well as racial disparities in health outcomes in Mississippi, and ensure consistent and adequate funding of this plan from the state legislature.

To the State Legislature

Pass legislation to expand Medicaid under the ACA to increase access to health care, including cervical cancer care, for Mississippi residents.

Repeal the ban on access to abortion and ensure everyone has equal access to the full spectrum of reproductive health care, including abortion care.

Increase funding for the Mississippi State Department of Health to ensure comprehensive, affordable, and accessible healthcare services are available to low-income and uninsured Mississippians at all 86 county health departments, including greater access to cervical cancer screenings and follow-up care.

Pass legislation to raise awareness of the human papillomavirus (HPV) vaccine and increase HPV vaccination rates in Mississippi that mandates:

dissemination of information on the adolescent vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) to the parents or guardians of all students in Mississippi entering the sixth grade;

education on HPV and the prevention of HPV-related cancers for all students starting in sixth grade; and

allocation of state funding to community-based organizations for public awareness and outreach campaigns around HPV, the HPV vaccine, and HPV-related cancers and their prevention, including the dissemination of information on the risk of cervical cancer for women ages 65 and older.

Pass legislation to require all Mississippi schools to provide comprehensive sexual health education that is age-appropriate, rights-based, scientifically accurate, inclusive, and responsive to all young people's needs.

Appropriate funds to support the implementation of comprehensive sexual health education in all Mississippi schools.

Pass legislation establishing a formal community health worker certification program in Mississippi to support community health outreach programs.

Institute and expand incentives for obstetrician-gynecologists and other healthcare providers to practice in the Mississippi Delta and other rural, underserved areas in Mississippi.

Increase funding and support programs and scholarships that assist minority and underrepresented communities in pursuing a career in health care to increase diversity within Mississippi's healthcare workforce.

In collaboration with communities and community-based development and advocacy organizations and agencies, support, develop, and fund initiatives and programs to increase the availability of accessible public transportation in the Mississippi Delta for the purposes of accessing healthcare services.

Adopt measures to expand available, accessible, and affordable high-quality telehealth services in rural areas to increase access to healthcare services.

To State Agencies, including the Department of Health and the Department of Education

Ensure reproductive health and cervical cancer services are available and accessible in the Mississippi Delta and other rural areas, including through the use of mobile health clinics.

In collaboration with communities, conduct public awareness and outreach campaigns to inform Mississippians of:

healthcare services, including cervical cancer care, offered by federal and state programs, including the MS-BCCP, and county health departments;

cervical cancer prevention and care, including the HPV vaccine, screenings, and follow-up care.

Support and fund community-based initiatives to increase awareness of and uptake of the HPV vaccine, including through vaccination clinics at schools, public health fairs, and other community events.

Develop and implement programs to ensure available, accessible, and affordable cervical cancer follow-up care, including colposcopies, in all communities with a focus on rural and underserved communities.

Support community health workers and community-based approaches to reproductive health care that address healthcare access and social determinants of health.

Partner with local communities, groups, and organizations to implement community-based initiatives to educate young people, including those who are out of school, on healthy sexual behaviors and address stigma around sexual health.

Disseminate information on HPV, the HPV vaccine, and the prevention of HPV-related cancers to parents or guardians of all students in Mississippi entering the sixth grade and ensure education on HPV and prevention of HPV-related cancers for all students starting in sixth grade.

Increase targeted outreach, awareness-raising, and trainings for healthcare providers to ensure they make strong recommendations for the HPV vaccine as an effective cancer prevention tool.

Ensure any updated versions of the Mississippi State Cancer Control Plan include clear goals, objectives, and indicators focused on increasing awareness of the HPV vaccine as well as HPV vaccination rates in Mississippi.

Ensure medical providers and all women, including those over 65, have access to information on the importance of cervical cancer screenings and the need for continued screening after age 65 for women at high-risk or with irregular or undetermined screening histories.

Require and provide cultural competency, implicit bias, and anti-racism trainings to healthcare providers to address how structural racism manifests within the healthcare field and impacts patients' treatment and quality of care.

Widely disseminate information on the complaint mechanism for patients who use public health departments, including information on how to access it, aggregate data on complaints received, and remedies implemented.

Ensure affordable and accessible transportation services for visits to the nearest county health department providing services and for follow-up care as needed is available to all Mississippians, especially in counties whose health departments have reduced hours and limited the availability of services.

To the United States Government To the President

Urge all US states that have not done so to adopt full Medicaid expansion.

Establish a national coordinating mechanism to monitor implementation and compliance with the International Convention on the Elimination of All Forms of Racial Discrimination.

Work with Congress to pass the Women's Health Protection Act or similar legislation creating legal protection for the right to provide and access abortion care throughout the US.

To Congress

Pass the Jeanette Acosta Invest in Women's Health Act or similar legislation aimed at addressing high rates of preventable cervical cancer deaths, including racial disparities in mortality rates.

Support Medicaid expansion in all 50 states as an important measure for addressing preventable gynecological cancer deaths.

Create a federal Medicaid-style program to expand affordable healthcare coverage to low-income individuals in the 10 states that have not expanded Medicaid until they have done so.

Fund a study and demonstration project on barriers to transportation impacting the ability of low-income individuals, particularly women of color, in rural areas to travel to appointments for cervical cancer screenings and follow-up care.

Stop funding abstinence-only education grants and health education programs that are scientifically inaccurate, discriminatory, or unresponsive to the needs of all students.

Ensure adequate funding for scientifically accurate, comprehensive sexual health education programs.

Enact the Real Education for Healthy Youth Act or similar legislation to support comprehensive sexual health education.

Pass the Women's Health Protection Act or similar legislation creating legal protection for the right to provide and access abortion care throughout the US.

Integrate into domestic law and policy the requirements of the Convention on the Elimination of All Forms of Racial Discrimination and the CERD Committee's August 2024 guidelines outlining steps governments should take to address racial discrimination in health care.

To the US Department of Health and Human Services

Recommend to the Health Resources and Services Administration (HRSA) that colposcopy, a diagnostic test for cervical cancer and precancerous lesions, and early interventions like ablative treatments, are included as preventive care under the ACA's essential health benefits mandate.

Review and adjust the current methodology for cervical cancer data analysis to ensure that it reflects the true rates of cervical cancer incidence and mortality. The review should consider whether including women with hysterectomies in the at-risk population artificially lowers reporting on racial disparities in cervical cancer rates.

To the American Cancer Society and the American College of Obstetricians and Gynecologists

Review current cervical cancer screening guidelines to ensure that they do not miss opportunities to prevent cervical cancer or lead to inequitable health outcomes on the basis of age or race.

 

The Southern Rural Black Women's Initiative for Economic and Social Justice (SRBWI) and Human Rights Watch jointly conducted the research for this report from September 2023 through November 2024. Ten community-based researchers—whom the partners recruited, onboarded, and trained—and a research associate based in the Mississippi Delta conducted qualitative interviews. Staff from Human Rights Watch and SRBWI jointly developed the research design, facilitated training for the community-based researchers, and conducted additional interviews and research analysis.

Individual interviews were conducted with 159 Black women in Bolivar, Humphreys, and Washington counties in the Mississippi Delta between September 2023 and April 2024. SRBWI and Human Rights Watch selected the Mississippi Delta because they sought to document the specific barriers that Black women living in predominantly rural and Black communities in the state face in accessing reproductive healthcare information and services. Bolivar, Humphreys, and Washington counties were specifically chosen because SRBWI has Human Rights Commissions in those counties headed by human rights commissioners who are actively engaged in local and regional advocacy and community-based initiatives.

Community-based researchers identified interviewees primarily through their established connections within their communities. However, outreach strategies, including the use of social media and flyers, were also used to help ensure diverse representation of women beyond these existing networks. Interviewees who disclosed their age were between the ages of 19 and 81 at the time that they were interviewed; three interviewees declined to disclose their age. Interviews were conducted in person at various locations in the counties convenient to the interviewees.

SRBWI and Human Rights Watch facilitated virtual and in-person training sessions for the community-based researchers on conducting ethical research to protect the safety and confidentiality of interviewees. They provided ongoing project supervision and research support through one-on-one check-ins as well as bimonthly group trainings and meetings.

SRBWI and Human Rights Watch also consulted or interviewed a total of 49 academics, medical providers, public officials, and members of nongovernmental health, reproductive rights, and justice groups in Mississippi.

SRBWI and Human Rights Watch conducted background research and analyzed quantitative data, including data compiled through publicly available sources and aggregate data about cervical cancer statistics in Mississippi.

Prior to the start of the project, three external advisors, including a community member from the Mississippi Delta, provided an independent research design review with the goal of ensuring that all appropriate steps had been taken to protect the rights of all participants involved in the research project. They reviewed project design and research materials—including informed consent protocols—and provided feedback, which SRBWI and Human Rights Watch worked to incorporate into final materials and design.

All interviews were conducted in English. All interviewees were informed of the purpose of the interview, its voluntary nature, and the ways that their information would be collected and used. They were also told that they could end the interview at any time or decline to answer any questions without negative consequences.

Community-based researchers adhered to specific protocols to ensure that the women they interviewed had consented to participate in the research in a fully informed manner. Prior to the start of interviews, women interviewed by community-based researchers received a written consent form, either through an electronic or hard copy. This document included a detailed explanation of: the purpose of the interview; its voluntary nature; the ways that information would be collected, securely stored, and used; any foreseeable risks associated with participating in the interview; and the contact information for project leads from SRBWI and Human Rights Watch. At the start of each interview, community-based researchers reviewed the full content of the consent form with the potential participant and proceeded with the interview only if the interviewee felt comfortable doing so.

For interviewees who wished to remain anonymous, this report uses a pseudonym, indicated in the footnote. For all others, we only use their first names and the initial of their last name to protect their privacy.

Community-based researchers received compensation for their time. In keeping with Human Rights Watch's standard practice, interviewees did not receive any compensation. Light refreshments such as snacks and water were offered during a few interviews. Interviews lasted from 20 minutes to one hour.

A Note on Terminology

This report uses the term "woman" in reference to those who are at risk of cervical cancer because the interviewees identified themselves as such. However, SRBWI and Human Rights Watch recognize that cervical cancer can impact anyone who has a cervix: women and people who do not identify as women, namely gender non-conforming people and some trans men. People who are at risk of cervical cancer who do not identify as women face unique challenges in accessing necessary sexual and reproductive health care, including cervical cancer care. This report does not include a focus on those unique challenges.

This report uses "people of color" when describing individuals and communities who may identify as: Black or African American; Hispanic, Latina, or Latinx of any race; Asian or Pacific Islander; North African or Middle Eastern; Indigenous; or multiracial. We use the term "Black" in reference to individuals of African descent or those who identify as such.

In this report, the term "child" refers to anyone under the age of 18, consistent with usage in international law. The report uses the term "adolescent" to refer to children and young adults ages 10 to 19, consistent with the World Health Organization's definition.

Finally, this report sometimes refers to distances to services as being "minutes away." This reflects the interviewee's approximation of how long a patient would expect to travel by car to reach a facility providing care. 

 

Cervical cancer is both highly preventable and highly treatable. The disease typically progresses slowly, providing time to detect and treat the early changes in cervical cells that could eventually lead to cancer. Almost all cases of cervical cancer are caused by a persistent infection with high-risk strains of a virus called the human papillomavirus (HPV),[1] which is the most common sexually transmitted infection in the United States.[2] Although most HPV infections typically clear up on their own within a few years, persistent infection with certain high-risk strains of HPV can cause changes in cervical cells that can lead to cancer.[3]

Cervical cancer deaths can largely be prevented through four key interventions:

Prevention, including access to information and the HPV Vaccine. The HPV vaccine is a safe and effective cancer prevention tool. It helps prevent six types of cancer, including cervical cancer. The Centers for Disease Control and Prevention (CDC) recommends two doses of the vaccine for all adolescent children ages 11 and 12 years, although the vaccine can be given as early as 9 years old and as late as 45.[4]

Routine cervical cancer screenings to detect abnormal changes in cervical cells at an early and treatable stage. Screening tests include: Pap tests (or Pap smears) which detect precancerous changes in cervical cells; and HPV tests which check for high-risk strains of HPV that can cause these changes in cervical cells.[5]

Timely follow-up after abnormal test results. If screening test results are abnormal, timely follow-up with a medical provider is necessary. Depending on the results, further testing and treatment options differ, with some individuals requiring only monitoring and repeated testing. Others may need a colposcopy, a procedure that uses a colposcope—a magnifying device—to allow a healthcare provider to look closely at the cervix.[6] A colposcopy usually includes a biopsy, a procedure which removes a piece of tissue from the cervix for closer examination under a microscope.[7]

Early and appropriate treatment. For some individuals, it may be necessary to treat and remove precancerous cervical lesions found during screenings and diagnostic tests. There are several procedures used to do so including: conization, often called a cone biopsy, which removes a cone-shaped piece of tissue from the cervix, including abnormal tissue; loop electrosurgical excision procedure (LEEP), which uses an electrical wire loop to remove abnormal tissue; laser ablation, which destroys abnormal tissue using a laser beam; and cryotherapy, a procedure that freezes and destroys abnormal cells.[8]

 

Overview of Mississippi, the Mississippi Delta, and Counties Covered in the Report Mississippi

Located in the southeastern United States, the state of Mississippi consists of 82 counties, 65 of which are considered rural areas by the US Census Bureau.[9] Mississippi is the state with the highest percentage of Black residents in the United States; about 38 percent of the population in Mississippi is Black.[10] Mississippi also has high rates of poverty, and almost 20 percent of Mississippians live below the federal poverty line—which is about $15,000 for a single-person household or $31,200 for a family of four in 2024—compared to approximately 12 percent nationwide in the United States.[11]

Mississippi is persistently ranked the worst in the country for many health indicators; in 2023, it was ranked last in the country for overall health in a report by the Commonwealth Fund.[12] Mississippi has high rates of obesity-related illnesses, heart disease, and other chronic illnesses.[13] As of 2018, Mississippi had the highest rate of amputations, almost triple the national average,[14] reflecti